Org OD 14 and the endometrium.

Long-term therapy with (7 alpha,17 alpha)-17-hydroxy-7-methyl-19-norpregn-5(10)-en-20-yn-3-one (Org OD 14; tibolone, Livial) has no influence on the endometrium in post-menopausal women. This was concluded from endometrial biopsies taken from 39 post-menopausal women treated with 2.5 mg/day for periods of from 3 months to 5 years 11 months at three centres. These results accord with the data published so far on 129 women who have been treated for up to 2 years. A review of the data relating to a total of 168 patients treated with Org OD 14 is presented. The endometrial pattern observed at the start of therapy showed no change during treatment in 90% of patients. In 15 cases slight proliferation was apparent after treatment, this being a similar pattern to that seen in the initial days of a normal cycle. In a considerable number of patients no tissue could be obtained, indicating an atrophic pattern. The picture following Org OD 14 therapy was the same as that observed in untreated normal post-menopausal women.

Influence of oral contraceptives on the incidence of premalignant and malignant lesions of the cervix.

The effect of oral contraceptive use on the development of severe dysplasia, carcinoma in situ and invasive carcinoma of the cervix was studied by a prospective longitudinal survey of 32,000 women. They were enrolled into the study between the ages of 15 and 39. Some had started oral contraceptive use before enrollment, others started after enrollment and some remained non-users throughout the study period. They were followed-up to 6-1/2 years. Analyses were performed on data from 24,784 women who met our criteria for incidence. Data were adjusted for years of follow-up, age at enrollment, age at first pregnancy, number of pregnancies, number of smears, and duration of use.

A randomized, double-blind study of two combined and two progestogen-only oral contraceptives.

A randomized double-blind study of two combined oral contraceptives and two progestogen-only oral contraceptives was conducted using the same protocol at WHO Collaborating Centres for Clinical Research in Human Reproduction in Bombay and Ljubljana of the 518 women admitted to the trial, 123 received mestranol 50 micrograms + norethisterone 1mg (MES 50 + NET 1); 137 received ethinyl estradiol 30 micrograms + levonorgestrel 150 micrograms (EE 30 + LNG 150); 130 received norethisterone 350 micrograms/NET 350); and 128 received levonorgestrel 30 micrograms (LNG 30). At one year, between 52.6 and 61.0 percent of those recruited had discontinued oral contraceptive use for all reasons, and by two years, between 70.5 and 76.5 percent had discontinued the treatment. These rates did not differ between the four treatment groups. However, discontinuation rates for all medical reasons at one and two years, and at two years pregnancy rates and discontinuation rates for bleeding disturbances, were significantly lower in the EE/LNG preparation. The groups receiving the MES/NET, LNG and NET had similar pregnancy rates, discontinuation rates for all medical reasons and all bleeding disturbances. There were two ectopic pregnancies among the 22 pregnancies in the progestogen-only groups. Discontinuation because of headache, dizziness and other central nervous system symptoms were significantly more common in those receiving MES/NET compared to EE/LNG. In contrast, discontinuation for gastro-intestinal disturbances were significantly higher in the EE/LNG combined preparation. Bleeding disturbances in the first few cycles tended to be higher in NET than in the LNG group. The data suggest that greater consideration be given to the benefits and risks of including progestogen-only oral contraceptives in the family planning programmes of some countries.

Obstetrics services--women's perspectives.

To obtain women's views of obstetric care 400 randomly selected mothers were interviewed postnatally. Since family planning is a constitutional right and all related services free of charge and virtually 100% of pregnant women attend the antenatal clinic, the questions asked were mainly oriented to evaluation of existing obstetric practice. Women were generally satisfied with labor and delivery care (71.2%), but as many as 88.2% of them expressed their dissatisfaction with postnatal care practice. Our women opted for optimal hospital perinatal care - a home-like postnatal care, possibilities for better bonding between mothers and newborn infants and more open, individually oriented communication with medical staff.

A comparison of flexible and nonflexible plastic cannulae for performing first trimester abortion.

The safety and effectiveness of flexible and nonflexible plastic cannulae used in vacuum aspiration abortion for patients at 6 to 12 weeks' gestation were evaluated in a study of 1100 physically healthy women in Ljublijana, Yugoslavia. To minimize study biases, each type of cannulae was randomly assigned to 550 patients. To minimize evaluator bias, a second physician who was kept unaware of which cannula was used for particular patient was responsible for evaluating patients after the procedures. Both groups of patients were similar with respect to age, parity, marital status, formal education and gestational age. Higher rates of retained tissue and cannula obstruction were obtained with the flexible cannula. The two types of cannulae were not significantly different with respect to other criteria of evaluation.

First trimester abortion by vacuum aspiration: interphysician variability.

This study compares the performances of four physicians using two types of plastic cannulae (flexible and rigid) for 1100 vacuum aspiration procedures. The criteria for assessing physician performance by cannula type were: (a) frequency of cannula obstructions, (b) amount of retained tissue obtained by sharp curettage after vacuum aspiration, (c) estimated blood loss during the procedure and (d) time required to perform the procedure. Data for each physician were compared and yielded significantly different results. The length of time required to use the cannula differed significantly among physicians; two of them had significantly shorter cannula times with the flexible instrument. The others had the lowest distributions of blood loss and the most difference between cannula usage. Consistent grouping over several variables suggests that differences in these criteria are more likely to be attributable to subtle distinctions in operator technique than to variations in equipment.

Time to conception after IUD removal: importance of duration of use, IUD type, pelvic inflammatory disease and age.

Some investigations of IUD use have demonstrated impaired ability to become pregnant after removal, while others have not. None of these studies, however, have adequately considered such potentially influencing variables as age and a history of pelvic inflammatory disease (PID). To study the effect of length of IUD use, IUD type and the modifying influences of age and PID history on time required to conceive, we followed women trying to become pregnant after removal of their IUD. Five hundred forty women in Ljubljana, Yugoslavia who were first fitted with an IUD between 1964 and 1972 and had their IUD removed in order to become pregnant were followed through 1980. We found no relationship between the duration of IUD use or type of IUD used, but increasing age and a history of PID each decreased the monthly probability of conception. These findings, along with other recent work, indicate that IUDs are a safe and efficacious contraceptive for women at low risk for sexually transmitted diseases.

PIP: Previous investigations of IUD use have demonstrated impaired ability to become pregnant after removal, while other studies have not. None of these studies, however, have adequately considered such potentially influencing variables as age and a history of pelvic inflammatory disease (PID). This investigation uses regression analysis to assess the influence of various factors individually on time to conceive. 540 women in Ljubljana, Yugoslavia, who were 1st fitted with an IUD between 1964 and 1972 and had their IUD removed to become pregnant, were followed through 1980. The COX regression model is used to assess simultaneously the influences of length of IUD use, device type (Lippes Loop), age at removal, parity, previous PID history, and duration of marriage on time to conception, thus controlling for the interrelationships between variables. This technique estimates the probability of conceiving at different times. Results indicate that duration of IUD use did not affect the time to conception. In addition, IUD type, duration of marriage or parity did not affect the time required to conceive. These findings demonstrate that the use of IUDs does not, in and of itself, lead to problems with subsequent fertility. However, these results underscore the importance of limiting IUDs to women who are not at high risk of sexually transmitted diseases.

[Sterilization--where are we and what do we want?]. / Sterilizacija--gdje smo i sto hocemo?

According to the estimation from the mid-eighties, about 135 million people were sterilized, 95 million females and 40 million males. In 1977, sterilization was legalized in Slovenia, in 1978 in Croatia. In the period from 1978 to 1989, 4,503 females and 654 males were sterilized in Slovenia. The majority of female sterilizations were performed in the interval and post partum (the third cesarean section), applying laparoscopy or mini-laparotomy according to Pomeroy, in some cases the obsolete Madlener technique, while vasectomies were performed by using the standard method. The accurate statistical data on complications are not available but are estimated to be minimal. Requests for a tubal or seminal duct reconstruction have been exceptional. With a higher number of sterilizations the incidence of induced abortions in women at the age of more than 35 years would be reduced and the use of contraception would be increased. Yugoslavia, besides Albania and the Soviet Union, was the last to resort to contraceptives.

[Perspectives of intrauterine contraception]. / Perspektive intrauterine kontracepcije

The author describes the current research in intrauterine contraception. It is directed in two ways: to improve the design of inert devices and to construct an optimal bioactive IUD. The design of the inert IUD should be adapted as much as possible to anatomical and functional conditions of the uterus. In developing new bioactive devices it is ained at finding the optimal dosage of metals and hormones as well as the new material acting as carriers of bioactive substances. With new constructions and the determination of the optimale dosage of antifertile and antifibrinolitic substances it is hoped to reduce three main insufficiences of intrauterine contraception: bleeding, expulsion and pregnancy.

[The effect of induced abortion in adolescence on the manifestations of spontaneous abortion, premature labor and birth weight]. / Utjecaj umjetnog prekida trudnoce u adolescentica na pojavu spontanog pobacaja, preranog poroda i na tezinu novorodencadi.

An experimental group of adolescents having become pregnant after induced abortion (n = 320) were compared with 514 primigravid adolescents, 391 women 20-24 years old having become pregnant after induced abortion, and 368 primigravid women of the same age. Spontaneous abortion appeared more frequently in the experimental group (5.9%) than in all control groups (5.1%, 3.3%, and 3.8% respectively. Preterm delivery was more frequent in the experimental group (9.3%) than in the control groups (6.8%, 6.4%, 5.7%, respectively). In the young adolescents (14-16 years old) of the experimental group, spontaneous abortion was almost twice as frequent (10.7%) as in the older adolescents of the same group (5.5%) and preterm delivery two and a half times as frequent (24.0%) as in the primigravid adolescents of the same age (10.3%). The weight of the newborns in the experimental group (3,155.7 +/- 536.3 g) was significantly lower than that in primigravid adolescents (3,228 +/- 488 g; t = 1.97, p less than 0.05), in women 20-24 years old with an earlier induced abortion (3,303 +/- 556 d; t = 3.49, p less than 0.01), and in primigravid women 20-24 years old (3.331 +/- 508; t = 4.30, p less than 0.001). The adolescents of the experimental group had on term deliveries in the 40th to the 42nd week significantly less frequently (31.6%) than primigravid adolescents (47.1%), 20-24 year-old women with earlier induced abortion (47.4%), and 20-24 year-old primigravid women (53.8%).

[The "Young Researchers" project--the effect on scientific research and educational potential in Slovenia]. / Projekt "Mladi istrazivaci"--uticaj na naucnoistrazivacki i pedagoski potencijal u Republici Sloveniji.

The aims and the development of the "Young Researchers" project, financed and headed by the "Research Association of Slovenia", have been described in this article. The goal of this project is to obtain new personnel resources for scientific research and developmental functions with a substantial expansion of personnel potential in research activity; a proportion of the 2000 young researchers is supposed to take part in the project by the end of 1990. They will renew the advisory personnel (researchers for renovation), and the other part, together with a defined number of already qualified researchers from research and university organizations, should be involved directly in immediate development and new production (researchers for development). The authors pointed to employment problems of new resources of young researchers (problems of administrative nature), as well as problems of qualification, and those of financial nature which appeared gradually during the implementation of the project. The actual project status has been presented after four years of its implementation, and the success of the project up to now, has been evaluated in terms of the project in general, and in medical science especially.

[Influence of the kind of anesthesia and length of hospitalization on the frequency of early complications of abortion]. / Utjecaj vrste anestezije i trajanja hospitalizacije na ucestalost ranih komplikacija pobacaja

A case-control study of the safety of early vacuum aspiration, when performed as an outpatient/inpatient procedure in local/general anaesthesia was undertaken in Ljubljana. Three thousand and four healthy women were observed. General anaesthesia was applied to 1509 women and local to 1495 women. The inpatient procedure required at least overnight stay, the outpatient one only five hours. No differences in complication rates of any clinical importance between the different types of services and anaesthesia were observed. The overnight stay resulted in no decrease in complications but in an even greater bed occupancy beyond that expected.

PIP: 3004 healthy women, pregnant from the 7th to the 12th week, were administered abortions as an outpatient/inpatient procedure with general/local anesthesia. A case-control study compared the results for the different procedures. The outpatient procedure required a 5-hour stay, the inpatient at least a 24-hour stay. 1509 women were given general anesthesia and 1495 local anesthesia. No significant differences in the rate of complications depending on the type of procedure and anesthesia were observed. Postabortal hemorrhaging did appear to be more frequent in those women using local anesthesia, but this is considered to be due to the method of abortion, here vacuum aspiration, and not connected to the type of anesthesia. The longer hospital stay did not decrease the number of complications, but did increase hospital bed occupancy more than expected.

IUD use after 40 years of age.

One hundred sixty-three IUD acceptors over the age of 34 at the time of insertion of the device were compared with 321 IUD acceptors under the age of 35 at the time of insertion. The older IUD acceptors were less educated, more likely to be married, and had more children and more induced abortions. At the time of last follow-up, 161 women were 40 years of age or older, and 323 were less than 40 years old. During 9 years of observations, there were fewer IUD removals and fewer side-effects during the last year of use in the older group of women. Questions relating to the risks of long-term IUD use and the use of hormone-releasing IUDs in this age group remain unanswered.

Dexamethasone and spironolactone in the treatment of non-tumorous hyperandrogenism.

To test the hypothesis that a combination therapy with dexamethasone and spironolactone in hirsute women with menstrual disorders due to non-tumorous hyperandrogenism might yield better results than monotherapy with spironolactone, we evaluated 25 women randomly assigned to dexamethasone-spironolactone (n = 15) and spironolactone (n = 10) groups. The Ferriman-Gallwey score and hormonal levels (LH, FSH, PRL, serum testosterone, androstenedione, dehydroepiandrosterone sulfate, estradiol, estrone and salivary testosterone) were determined before and after 6 months of therapy. There were comparable results, with a significant drop in the Ferriman-Gallwey score, in serum androstenedione and estrone concentrations and in salivary testosterone levels in both groups. The only difference between the two groups after therapy was a significant fall in serum dehydroepiandrosterone levels in patients treated with the combination therapy. The results indicate that the combination therapy with spironolactone and dexamethasone presents no real advantage over therapy with spironolactone alone, for the initial treatment of non-tumorous hyperandrogenism.

[Abortion in the world and in Slovenia]. / Splav po svetu in pri nas.

PIP: Global abortion trends are reviewed, with some reference to the abortion situation in Slovenia. (SUMMARY IN ENG)^ieng